Health Policy Commons^™

Multi-State Plans Under The Affordable Care Act, Trish Riley, Jane H. Thorpe

Health Policy and Management Faculty Publications

New state health insurance exchanges that are developing under The Patient Protection and Affordable Care Act (ACA) will offer consumers a choice of private health plans known as qualified health plans (QHPs). Under the law, in every state, two of those must be multi-state plans or MSPs. These plans will be administered by the federal Office of Personnel Management (OPM). The MSPs must meet the same requirements as other QHPs. As with other QHPs, people enrolled in the plans will be eligible for premium tax credits and cost sharing assistance if their income is less than 400 percent of poverty …

Saving Money: The Massachusetts Tobacco Cessation Medicaid Benefit: A Policy Paper, Leighton C. Ku, David Zauche, E. Ripley Forbes

Health Policy and Management Faculty Publications

In the United States, about 70% of smokers want to quit and 50% make a quit attempt each year. Unfortunately, only a small percent are successful, due in part to the lack of easy access to tobacco dependence treatments that have been proven effective. In light of the societal costs of tobacco-related illness, government must do everything it can to encourage and enable smokers to quit.

The tobacco use landscape in this country has changed in recent years -- people with lower income and education levels have a much higher probability of smoking. For instance, the smoking rate for those …

The Return On Investment Of A Medicaid Tobacco Cessation Program In Massachusetts, Patrick Richard, Kristina West, Leighton Ku

Health Policy and Management Faculty Publications

Background and Objective

A high proportion of low-income people insured by the Medicaid program smoke. Earlier research concerning a comprehensive tobacco cessation program implemented by the state of Massachusetts indicated that it was successful in reducing smoking prevalence and those who received tobacco cessation benefits had lower rates of in-patient admissions for cardiovascular conditions, including acute myocardial infarction, coronary atherosclerosis and non-specific chest pain. This study estimates the costs of the tobacco cessation benefit and the short-term Medicaid savings attributable to the aversion of inpatient hospitalization for cardiovascular conditions.

Methods

A cost-benefit analysis approach was used to estimate the program's …

Building A Relationship Between Medicaid, The Exchange And The Individual Insurance Market, Sara J. Rosenbaum, Trish Riley

Health Policy and Management Faculty Publications

The alignment of Medicaid and State Health Insurance Exchange (Exchange) policy and practice is a basic tenet of the Patient Protection and Affordable Care Act (ACA). Through both legislative provisions and implementing regulations, the ACA addresses this relationship. At the same time, the federal framework provides states with considerable discretion to flesh out the fuller dimensions of system interaction.

Promoting The Integration And Coordination Of Safety-Net Health Care Providers Under Health Reform: Key Issues, Leighton C. Ku, Peter Shin, Marsha Regenstein, Holly Mead

Health Policy and Management Faculty Publications

The Affordable Care Act includes several provisions designed to encourage greater coordination and integration among health care providers, including the promotion of accountable care organizations and health homes. While much discussion has focused on how these strategies might be adopted by Medicare and private insurers, little attention has focused on their application among safety-net health care providers. Such providers face particular challenges in coordinating care for their low-income and uninsured patients, and no single approach is likely to meet their diverse needs. Successful efforts will require federal, state, and local financial resources to sustain the safety net and make the …

Transforming Community Health Centers Into Patient-Centered Medical Homes: The Role Of Payment Reform, Leighton C. Ku, Peter Shin, Emily Jones, Brian K. Bruen

Health Policy and Management Faculty Publications

This report examines how changes in the way federally qualified health centers (FQHCs) are financed could support the transformation of these critical safety-net providers into high performing patient-centered medical homes. Through surveys and interviews, the authors explore the current landscape of health center involvement in medical home initiatives, adoption of medical home standards, and receipt of payment incentives. Based on their findings, the authors make preliminary recommendations to encourage health centers to serve as patient- and community-centered medical homes. These include: establishing recommended standards for patient- and community-centered medical homes that apply to FQHCs; structuring payment incentives to promote medical …

State Insurance Exchanges: An Overview, Sara J. Rosenbaum

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

The View From New Hampshire: The Imperative Of Linking Health Care Reform To Economic And Job Growth, Maggie Wood Hassan

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges, Benjamin D. Sommers, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The Affordable Care Act will extend health insurance coverage by both expanding Medicaid eligibility and offering premium subsidies for the purchase of private health insurance through state health insurance exchanges. But by definition, eligibility for these programs is sensitive to income and can change over time with fluctuating income and changes in family composition. The law specifies no minimum enrollment period, and subsidy levels will also change as income rises and falls. Using national survey data, we estimate that within six months, more than 35 percent of all adults with family incomes below 200 percent of the federal poverty level …

Estimating The Economic Gains For States As A Result Of Medicaid Coverage Expansions For Adults, Peter Shin, Leighton C. Ku, D. Richard Mauery, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This policy research brief examines the Medicaid eligibility expansions under the pending legislative proposals, including the House Tri-Committee bill, the Senate Health, Education, Labor and Pensions Committee bill and the Senate Finance Committee bill. Using new Census Bureau data, the researchers find that under both the House and Senate Finance Committee proposals, about 9.6 million nonelderly adults would gain Medicaid eligibility by 2014. Furthermore, the federal and state expenditures are less than Medicaid's positive impact on the economy amounting in a return of three dollars in new business activities for every dollar of state Medicaid investment. Because Medicaid is designed …

Health Center Data Warehouses: Opportunities And Challenges For Quality Improvement, A. Seiji Hayashi, Emily Jones, David M. Stevens, Peter Shin, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This Policy Research Brief reports on a pilot effort to leverage the growing presence of health center data warehouses to advance health care quality improvement through data sharing and exchange. This project builds on a partnership between the Michigan Primary Care Association and The George Washington University's Geiger Gibson/RCHN Community Health Foundation Research Collaborative that centers on developing approaches to using existing health center data for quality improvement.

Financing Community Health Centers As Patient- And Community-Centered Medical Homes: A Primer, Peter Shin, Leighton C. Ku, Emily Jones, Brad Finnegan, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This policy brief is part of a Commonwealth Fund-supported project that examines community health centers in the context of the patient-centered medical home (PCMH) movement. Community health centers—non-profit primary care facilities that provide care to patients regardless of their ability to pay—are widely lauded as critical components of the health care safety net, providing comprehensive primary care for lowincome, high-risk populations in both urban and rural areas. Since their inception, health centers have directed their activities at improving patient care—through comprehensive primary health care, coordination with specialty care, and the provision of enabling services—as well as improving population-level health status …

Primary And Preventive Healthcare: A Critical Path To Healthcare Reform For Florida: The Role Of Florida's Fqhcs, Sara J. Rosenbaum, Peter Shin, Brad Finnegan, Ramona Whittington

Health Policy and Management Faculty Publications

Florida's health care system faces numerous challenges: a high proportion of residents without health insurance, a declining supply of primary care physicians at the same time that the state faces a growing need for high quality and cost efficient care for uninsured persons, and a growing emphasis on medical homes, especially for culturally diverse patients with complex chronic conditions. Nearly 3.8 million Florida residents lack health insurance, while more than 8 million lack access to a regular source of primary health care.

Assuring access to timely and high quality primary health care is a key dimension of any health reform …

Liability Protections For Emergency Volunteer Health Practitioners And Entities, Jennifer Lee, Orriel L. Richardson, Ross Margulies, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Twenty-four states and D.C. have statutes that extend some level of immunity to groups and/or organizations providing charitable, emergency, or disaster relief services, although these laws varied greatly among states.

From Schip Benefit Design To Individual Coverage Decisions, Anne R. Markus, Sara J. Rosenbaum, Ruth E. K. Stein, Jill Joseph

Health Policy and Management Issue Briefs

The majority of states have implemented separate SCHIP (S-SCHIP) programs that significantly depart from Medicaid and resemble less comprehensive commercial products. This difference in program design may result in S-SCHIP potentially being less responsive to children with special needs (CSHCNs). This study explores how responsive insurers are to these higher than average needs. We found that, with one exception, insurers did not agree on the coverage of any specific service, but overall they provided coverage beyond state limits and exclusions. Second, the less acute the childhood condition, the more frequently insurers imposed exclusions. Finally, in the majority of states, some …

The Epidemiology Of U.S. Immunization Law: Translating Cdc Immunization Guidelines Into Practice: State Laws Related To The Use Of Standing Orders Covering Immunization Practice, Alexandra M. Stewart, Marisa A. Cox, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This pilot study examines how five states -- Georgia, Massachusetts, New York, Oregon, and Texas – approach the legal question of delegation of medical practice powers in an immunization practice context.

Achieving "Readiness" In Medi-Cal's Managed Care Expansion For Persons With Disabilities: Issues And Process, Sara J. Rosenbaum, Sara E. Wilensky, Peter Shin

Health Policy and Management Faculty Publications

This Policy Brief examines issues that can be expected to arise as California moves to significantly expand the use of mandatory managed care arrangements for Medi-Cal enrollees with disabilities. This analysis is based on information gleaned from more than a decade of Medicaid managed care specification analyses for the federal government and private funders, focusing on both the general beneficiary population and persons with chronic illnesses and disabilities. This Policy Brief also reflects experiences in furnishing technical assistance to state purchasers and in developing model managed care purchasing specifications for both general and special needs managed care populations for both …

An Assessment Of Hospital-Sponsored Health Care For The Uninsured In Polk County/Des Moines, Iowa, Lea Nolan, Marsha Regenstein, Marisa A. Cox

Health Policy and Management Faculty Publications

Health care providers in Polk County are faced with increasing numbers of low-income, uninsured patients who do not have the resources to pay for their health care out of pocket. At the same time, state and local funding sources are limited, and are insufficient to ensure that these individuals have access to the health services that they require. Community leaders are extremely interested in developing information to understand the magnitude of the uninsured problem in Polk County and to identify health care delivery strategies to better serve this population. A Blue Ribbon Steering Committee was convened in October 2004 to …

Olmstead V. L.C. And The Americans With Disabilities Act: Implications For Public Health Policy And Practice, Joel B. Teitelbaum, Taylor Burke, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This installment of Law and the Public’s Health examines the meaning of Olmstead v. L.C. for public health agencies administering personal health care programs. Handed down by the U.S. Supreme Court in 1999, Olmstead was a landmark decision that interpreted the Americans with Disabilities Act (ADA or the Act) as it applies to public programs and thus is of great relevance to many public health agencies. Following an overview of the decision and its interpretation by lower federal courts, this column concludes with a discussion of the implications of Olmstead and its progeny for public health policy and practice.

An Assessment Of The Safety Net In Lincoln, Nebraska, Lea Nolan, Lissette Vaquerano, Karen C. Jones, Marsha Regenstein

Health Policy and Management Faculty Publications

This report examines key issues that shape the health care network available to uninsured and under-served residents in Lincoln. It provides background on the Lincoln health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

The safety net assessment team's analysis of the Lincoln safety net …

Public Health Insurance Design For Children: The Evolution From Medicaid To Schip, Sara J. Rosenbaum, Anne R. Markus, Colleen Sonosky

Health Policy and Management Faculty Publications

In 2005 Medicaid will turn 40, a momentous event in the life of the largest and most complex of all means-tested public entitlement programs. Since 1997, Medicaid has co-existed with the State Children’s Health Insurance Program (SCHIP), a small program which covers a fraction of the number of Medicaid enrolled children but whose legislative structure looms large against its much beleaguered companion. To the unpracticed eye, SCHIP and Medicaid appear to be quite similar in design; in reality however, their differences could not be more profound, and it is in these differences that clear directions for Medicaid’s possible future become …

Health Coverage In Massachusetts: Far To Go, Farther To Fall, Sara J. Rosenbaum, Jeanne Lambrew, Peter Shin, Marsha Regenstein, Tanya Ehrmann, Dylan Roby

Health Policy and Management Faculty Publications

This analysis has been prepared to highlight the state's experience in health reform and describe the challenges that it now faces. It recommends a renewed commitment to maintaining and strengthening the reforms that have made Massachusetts one of the nation's health policy leaders. This analysis does not focus on comprehensive health reform, although we believe that the cost and coverage problems that plague the Massachusetts health system (as well as that of every other state) would be most effectively addressed through broader restructuring aimed at achieving universal coverage and more decisive control over expenditures. In this report, we instead focus …